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General NPI Number Information
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NPI Number | 1336836170
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Entity Type | Organization
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Legal Business Name | VITALX HEALTH LLC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 19001 SW 106TH AVE UNIT C109
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City | CUTLER BAY
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State | FL
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Zip | 33157-7669
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Country | US
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Telephone | 305-964-5425
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Fax | 305-964-5465
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Provider Business Mailing Address
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Address Line | 19001 SW 106TH AVE UNIT C109
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City | CUTLER BAY
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State | FL
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Zip | 33157-7669
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Country | US
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Telephone | 305-964-5425
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Fax | 305-964-5465
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Authorized Official
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Title or Position | OWNER
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Name | VIVIAN T GIRALDO
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Credential | APRN
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Telephone | 305-497-4007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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